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Anesthesia for Surgical Procedures There are three subgroups of anesthesia: general, regional and local anesthesia. General anesthesia is defined as a state characterized by unconsciousness, analgesia, muscle relaxation and depression of reflexes. Under general anesthesia there is no awareness of the surgical procedure. With a regional anesthetic, local anesthesia is used to numb the surgical area. Regional anesthesia includes spinal and epidural anesthesia as well as specific nerve blocks. With a local anesthetic, the surgeon numbs the surgical site. Many time this done with intravenous sedation provided by the anesthesia care team. This technique is called MAC for Monitored Anesthesia Care. Analgesia for Childbirth Epidural An epidural is chosen by a large majority of women in this country because it eases the discomfort of child-birth yet allowing the mother and baby to remain mentally alert. Epidural refers to the space in your lower back between the outer covering of the spinal cord and the backbone. Nerves travel across this area carrying pain messages and other sensations from your body to your brain. When a local anesthetic is injected into the epidural space it blocks the sensations, giving you relief from pain in that part of your body. When your care team provider inserts an epidural, first he numbs the skin where the epidural will be placed. Then he inserts a tiny plastic tube into the epidural space, below the end of the spinal cord. Carefully controlled amounts of the medicine are administered through the tube as needed. The insertion of the anesthetic usually takes about five to ten minutes. Numbness over the lower abdomen and legs provides intense pain relief. After an initial dose, further medication is provided by a constant infusion pump, so that pain relief may continue until delivery. Cesarean Section If your obstetrician determines that a Caesarean delivery is necessary, an epidural can often be utilized for this as well. The advantage of an epidural for Caesarean (C-Section) delivery is that you can be awake, comfortable and can interact with your baby shortly after delivery. Occasionally, a general anesthetic (in which the mother is put to sleep) must be done for a Caesarean delivery. Every effort is made to utilize another method when it is safe to do so. Regional Anesthesia This allows the patient to be awake and comfortable for the birth of the baby. If a labor epidural is already in place, further medication is injected through it to make the mother intensely numb. Sometimes the epidural is inserted in the operating room just prior to surgery. A Spinal Anesthetic This is very similar to an epidural, but is usually reserved for C-Sections. A very fine needle is used to inject a small amount of local anesthetic into the spinal fluid, below where the spinal cord ends. This provides the intense numbness required for C-Section much more quickly and reliably than an epidural, and using much less medication. In the past this technique frequently caused headaches afterwards, but with modern very thin needles the chance of this happening is less than 1%. Pain Medicine Pain is an experience that is familiar to all of us. It is a warning signal that something is wrong. Usually, pain is the result of an injury, illness or surgery and it goes away as part of the normal healing process. This is called "acute" pain. Sometimes, however, the pain persists even after the original cause of the pain has healed. This is called "chronic" pain. Our Pain Specialists provide comprehensive care for a wide range of painful conditions including: Cancer pain, acute herpes zoster pain/post herpetic neuralgia, radicular spinal pain, reflex sympathetic dystrophy, myofascial pain syndromes, neuropathic pain syndromes, and post surgical pain syndromes. |